**Question:** A 28 years old male, who was known case of mitral valvular heart disease developed weakness on right side of body which gradually recovered completely over a period of 2 weeks. Blood pressure of the patient was normal and laboratory studies did not reveal any significant abnormality. What is the diagnosis?

**Core Concept:** Mitral valvular heart disease refers to a condition where the mitral valve, one of the four heart valves, is damaged or dysfunctional. This can lead to various symptoms and complications, including hemodynamic instability, arrhythmias, and neurological manifestations. In this scenario, the patient is known to have mitral valvular heart disease, which predisposes them to potential complications.

**Why the Correct Answer is Right:** The patient's weakness on the right side of the body, along with a recovery over two weeks, suggests an acute event. Given the known history of mitral valvular heart disease, a possible diagnosis is an embolic stroke due to embolization from a damaged heart valve. The patient's normal blood pressure and unremarkable laboratory studies further support that the neurological symptoms are not related to systemic hypertension or other systemic causes.

**Why Each Wrong Option is Incorrect:**

A. Acute myocardial infarction: This diagnosis is unlikely due to the absence of chest pain, electrocardiographic changes, and normal blood pressure.
B. Chronic ischemic stroke: The acute onset and rapid resolution of symptoms make this diagnosis less likely.
C. Chronic demyelinating polyneuropathy: This diagnosis is inconsistent with the described acute neurological presentation and spontaneous recovery.
D. Acute cerebellar degeneration: Similar to option C, this diagnosis is less likely due to the acute onset and spontaneous recovery of symptoms.

**Core Concept:** The correct diagnosis of embolic stroke due to mitral valve dysfunction is a valuable lesson for students to understand the potential neurological manifestations of cardiovascular diseases and the importance of a thorough medical history and physical examination in guiding the diagnosis.

**Clinical Pearl:** In cases of stroke in patients with cardiovascular risk factors or known heart disease, a thorough neurological examination and inquiry into cardiac symptoms are essential to consider the possibility of embolic stroke due to heart valve dysfunction. This prompts the need for appropriate imaging studies (e.g., CT angiography) to confirm the diagnosis and initiate appropriate treatment, such as anticoagulation therapy.